Anesthesia Coding Alert

Question: What is the most appropriate method for coding and billing for conscious sedation during pain management procedures? Pennsylvania Subscriber Answer: Two CPT codes can be used for conscious sedation, depending on the route of delivery: 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 ( oral, rectal and/or intranasal). While 99141 is more commonly used, both codes describe procedures that require monitoring by a certified anesthesia professional, such as a CRNA, but not necessarily by a physician. Both of these codes are reimbursed as a flat fee based on relative value units (RVUs); therefore, coders should not submit them as time services (as with anesthesia codes).

Medicare and many Blue Cross Blue Shield plans will not reimburse for conscious sedation but will consider claims with supporting documentation for services where unusual circumstances precipitated the medical necessity of conscious sedation, such as a pediatric patient who was unable to lie still.

Some private carriers, however, will reimburse when conscious sedation is provided in addition to the pain management procedure (e.g., 62310, Injection, single ... epidural or subarachnoid; cervical or thoracic). Coders and billers should ask their patients' carriers for processing policies.